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Characteristics and Misdiagnoses of Gifted Children

This article explores the characteristics and behavior patterns of gifted children that can lead to misdiagnoses, such as ADHD or learning disabilities. It also discusses common disorders and easy rule outs. Contact Paul Beljan, PsyD, for more information.

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Characteristics and Misdiagnoses of Gifted Children

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  1. Paul Beljan, PsyD, ABPdN, ABN 9835 E. Bell Rd., Ste. 140 Scottsdale, AZ  85260 (602) 957-7600 www.beljanpsych.com p.beljan@beljanpsych.com Twitter@BeljanPsych http://motorcognition2.com/ Paul Beljan (602) 957-7600

  2. Paul Beljan (602) 957-7600

  3. Bell Curve and IQ • Characteristics of Gifted • Common Disorders • Common Misdiagnoses • Discrepancy Model and Learning Disability • Easy Rule Outs • What to do? Paul Beljan (602) 957-7600

  4. Distribution of Intelligence Quotients BeljanPsychological Services (602) 957-7600

  5. CHARACTERISTICS AND BEHAVIOR PATTERNS OF GIFTED THAT CAN LEAD TO MISDIAGNOSES • Asynchronous Development • Impatient with other people during periods of intense focus • Neglects duties in favor of reading or interests • Advanced and diverse interests (jumps from one to the next) • Narrow interests (could be a lifetime focus ex. Light=Einstein) • Reluctant to move to new activities-transitions • Makes jokes or puns at inappropriate times Beljan Psychological Services (602) 957-7600

  6. CHARACTERISTICS AND BEHAVIOR PATTERNS OF GIFTED THAT CAN LEAD TO MISDIAGNOSES • Judgment/awareness lags behind intellect/insight • Poor handwriting • Lacks interest in details (ex. does math in mind) • Turns in messy work (works too fast) • Unusual sleep patterns • Peer relation problems, unless with like intellectual peers Beljan Psychological Services (602) 957-7600

  7. CHARACTERISTICS AND BEHAVIOR PATTERNS OF GIFTED THAT CAN LEAD TO MISDIAGNOSES • Emotional sensitivity and intensity (“over-excitabilities”) • Strong-willed; power struggles • Boredom if educationally misplaced • Resists routine/repetitive practice • Creative, non-traditional thinking style • Feeling on equal footing with adults Beljan Psychological Services (602) 957-7600

  8. CHARACTERISTICS AND BEHAVIOR PATTERNS OF GIFTED THAT CAN LEAD TO MISDIAGNOSES • Challenging; non-conformist; disrupts status quo • Refuses to accept authority; stubborn • Idealism/fairness • Impatient with failures/disappointment • Self-critical; perfectionism; unwillingness to take risks • Oversensitivity to criticism; may overreact • Easily becomes angry or cries when things go wrong Beljan Psychological Services (602) 957-7600

  9. Attention Deficit/Hyperactivity Disorder (ADHD) Oppositional Defiant Disorder (ODD)/Conduct Disorder Learning Disabilities (LD) Obsessive-Compulsive Disorder (OCD) Autism Spectrum Disorder (ASD) Major Depressive Disorder (MDD) Bi-polar Disorder Dysthymic Disorder Narcissistic Personality Disorder Avoidant Personality Disorder Intermittent Explosive Disorder Schizoid Personality Disorder FREQUENT MISDIAGNOSES OF GIFTED CHILDREN Beljan Psychological Services (602) 957-7600

  10. Learning Disabilities (LD) Exec Function Based LD (PAC) Attention Deficit/Hyperactivity Disorder (ADHD) Asperger’s Disorder (AD) Allergies (particularly food) Reactive Hypoglycemia Obsessive-Compulsive Disorder Parent-Child Relationship Problems Relational Problems with peers Depression (existential) Sleep Issues nightmare sleep terror sleepwalking DISORDERS THAT COMMONLY INVOLVE GIFTEDNESS (2e) Beljan Psychological Services (602) 957-7600

  11. Diagnosing 101: Rule out the easy stuff • Short Term Memory • Processing Speed • Auditory Processing • Sensory Integration • Oppositional Defiant • Spectrum Disorder (Conspiracy) Paul Beljan (602) 957-7600

  12. Base Rates • Clustering symptoms and factoring them against the age, gender, weight, SES, culture, etc., of the patient to quickly reduce many possible diagnoses down to a few likely diagnoses. Paul Beljan (602) 957-7600

  13. Short Term Memory • First, consider how significantly impaired a child would be if he/she had a short term memory deficit. • Learning would be completely impaired. • If a child never suffered had an inutero or birth injury, became asphyxiated, experienced a severe blow to the head, or had any other seizure or disease process involving the brain; then what would be the likelihood of them having a short term memory deficit? • The answer is nearly zero. Paul Beljan (602) 957-7600

  14. Short Term Memory • If children perform well on only one encoding task, they do not have a short term memory deficit; because how could a child do well on any task of encoding if they have a short term memory deficit? They could not. • You cannot fake a skill if you do not have it. • When this is determined, then I begin to look at what causes a child to seem like they have a short term memory deficit when in fact they do not. Paul Beljan (602) 957-7600

  15. Short Term Memory • One must pay attention to information meant for encoding in order for that information to be encoded into short term memory. • Gifted children are often bored in class or taken with their own entertaining thoughts. • If information is not encoded then the result is a child who seems to have a short term memory problem, when the child actually was not listening or was distracted. Problem solved. Paul Beljan (602) 957-7600

  16. Processing Speed David Letterman “Top 10 List” “How do you know you have a dumb dog? There is a long delay between Bow and Wow.” Paul Beljan (602) 957-7600

  17. Processing Speed • Three tests on the Wechsler Intelligence Scale for Children- fourth edition (WISC IV) can rule out a speed deficit. • Symbol Search • Coding • Block Design Paul Beljan (602) 957-7600

  18. Processing Speed • Compare the WISC IV SS and Cd tests to the BD test. • Double checking work on SS and Cdcauses the child to earn correct responses, but less of them, ultimately rendering a lower score. • Gifted children frequently yield fast BD times (under 10 seconds) on the 45 second items and earn bonus points for fast completion on the more difficult 120 second items. • Low scores on SS or Cd and high scores on BD rules out a cognitive speed deficit, and vice-versa. • **recent TBI dx based on misinterpretation of SS and CD in forensic case Paul Beljan (602) 957-7600

  19. Auditory Processing • APD is commonly questioned by parents of gifted children. • APD has numerous definitions. • Most consistently it means the physical elements of the outer and inner ear function, but the child has difficulty processing and making sense of how language sounds in their head. • This seems more like a receptive language disorder than an audition issue. Could Be: Engrossed in their thoughts/activity = not listening Paul Beljan (602) 957-7600

  20. Auditory Processing • True APD is rare and impairing. • I only see it co-morbidly with phonological processing deficit. • Get an audiology evaluation in addition to neuro/speech-language evaluation. • The child tries to identify a given sound while a competing sound is presented. • In my experience, children with attention deficit have the same problem, but no one claims it is an APD. • Attention deficit is a disorder of sustaining and prioritizing attention. Paul Beljan (602) 957-7600

  21. Sensory Integration • Sensory Integration Disorder (SID): • Think Asynchronous Development • SID basically means the child’s sensory system is working well, but their frontal lobe (i.e., cerebellar-thalamocortical-basal ganglial-neostriatal-frontal circuitry) mediation of the sensory stimulus has not developed to the extent that it can be put in the background of experience. • In other words, the child cannot yet inhibit/modulate sensory experience; it does not mean the sensory system is impaired (Koziol 2010 & 2011). Paul Beljan (602) 957-7600

  22. Sensory Integration • Why does treatment help? • The sensory system is working well. • Tx feels really good and the response is temporary • Tx is external soothing • The px comes back fast • The px resolves with time and higher cortical development (i.e., inhibitory control) • Bonus caveat: Ever meet an adult with SI? Paul Beljan (602) 957-7600

  23. Oppositional Defiant Disorder • ODD is made, not born. • Parent/Parents/Caretaker; home; food; warm bed; hugs and told, “I love you.” • Does the dx exist across environments? • School only? Home only? Socially only? Paul Beljan (602) 957-7600

  24. Oppositional Defiant Disorder • Is the child overly indulged for intellect? • Negotiating? Arguing? Tantruming? Defying? • “Why” before compliance? • Has the child been assisted to develop a full identity that does not stand solely on intellect? • They were born on the intellectual 3rd base; they did not hit a triple. • Are inappropriate behaviors overlooked and justified as high intellect? • Sports figure Narcissism Paul Beljan (602) 957-7600

  25. Oppositional Defiant Disorder • ADHD children who are gifted cannot reliably and consistently express working memory, inhibition, and sustained attention for as long as they want and whenever they want, and their variable expression causes a ‘Swiss cheese’ effect in academic and behavioral performance. • These children often are identified as willful or oppositional because when they are experiencing an ‘ADHD moment’ and their working memory, inhibition, and sustained attention is undermined, they cannot execute a previously expressed skills, and that looks willful. Paul Beljan (602) 957-7600

  26. AUTISM SPECTRUM CONSPIRACY • No insurance support before 2003ish • Insurance has to pay for ASD tx -2004ish • Why? • Big pharma & lobbyists • ASD tx is often drugs • Psychiatry prescribes the drugs • Psychiatry writes the DSM • The diagnostic bar is lowered FOLLOW THE MONEY Paul Beljan (602) 957-7600

  27. LEARNING DISABILITIES • Why discrepancy model is wrong • Reading/Spelling (Dyslexia) • Math (Dyscalculia) • Hand Writing (Dysgraphia) Paul Beljan (602) 957-7600

  28. The Discrepancy Model (DM) • IQ is 22 points (1.5 standard deviations) above achievement scores • The child functions two grade levels below placement • Led to most children in USA not receiving specialized reading remediation until 3rd grade because you cannot get two grade levels below 1st or 2nd grade. • Bush II era replaced PL 94-142 with IDEA, which rang in teaching to the AIMS test Paul Beljan (602) 957-7600

  29. The Precursor: What Must Be Known Before Advocacy Begins Paul Beljan (602) 957-7600

  30. How do you know who to see? Ask yourself: What is the origin of the problem? • Medical • Brain Based • Learning Based • Emotional Based • Trauma Based Paul Beljan (602) 957-7600

  31. How do you know who to see? • Rule out everything medical first • Many medical disorders mask as psychological issues • Thyroid • Bladder Infection • Allergies/Food Sensitivities • Low vitamin and amino acid levels • Genetic syndromes Paul Beljan (602) 957-7600

  32. When the only solution in the toolbox is a hammer, then every problem looks like a nail • Psychiatry • Developmental understanding of children? • Arranging cars • Pouring water • Tantrum Bx • Toe walking; flapping; eye contact (shy vs gaze avoidant) • Distractibility • Hyperkinesis Paul Beljan (602) 957-7600

  33. How do you know who to see? • A neuropsychological Assessment accounts for everything • Development • IQ • Academic Achievement • Attention/Executive Function • Learning and Memory • Speech/Language • Sensory Motor/Visual Spatial • Spectrum – one swallow does not make a summer Paul Beljan (602) 957-7600

  34. How do you know who to see? • Rule out everything psychological Emotional/Family/Social/Trauma • Asynchronous Development • Intensity • Innate anxiety/depression/OCD • Toxic living environment • Experiencing/witnessing a traumatic event • Incongruent fit between intellect and school environment • Bullying • Undiagnosed giftedness or learning disorder Paul Beljan (602) 957-7600

  35. Finding the appropriate professional • What is their training/knowledge base in gifted? • If they are neuropsych: What was their training in neuro and gifted? • APA Internship • APPIC Post-doc in neuro (at least one full year) • If they are medical: Do they acknowledge gifted? Paul Beljan (602) 957-7600

  36. Professional Civility • Will they give you 10 min to interview them: free? • Will they take a short phone call at times: free? • Do they bill you for a fax or a short letter? • Are they more about money than your child? • Do they call you back within 24 hours? Paul Beljan (602) 957-7600

  37. When Disorders are NOT Disorders: • A pediatric neuropsychologist looks at all elements of functioning as opposed to individuals who specialize in one area and tend to only look for and find issues within their wheelhouse of knowledge. It takes a whole brain to function, so the whole brain should be evaluated to rule out erroneous diagnoses. Paul Beljan (602) 957-7600

  38. Learning Disabilities are Brain Based Disorders • The neuropsychology of LD it too vast and complex for this discussion; suffice it to say the following: • To execute skills and tasks the brain functions in a multimodal manner that is highly interdependent upon the interactions between the micro-systems of neurochemicals and neurons to pathways, and the macro-systems of the limbic system, white matter, grey matter (higher cortical processing), and the cerebellum. • 135 iq with 100 Achievement scores = LD, but the gifted child will not receive services. Paul Beljan (602) 957-7600

  39. When Disorders are NOT Disorders: Katz, J., et al. Handbook of Clinical Audiology Sixth Ed. Lippincott Williams & Wilkins, 2009. Green P., Josey, F. The Use of an Earplug to Increase Speech Comprehension In a Subgroup of Children with Learning Disabilities: An Experimental Treatment. Applied Neuropsychology. 2002, Vol. 9, No. 1, 13–22. Koziol LF, Budding DE, Chidekel D. Sensory Integration, Sensory Processing, and Sensory Modulation Disorders: Putative Functional Neuroanatomic Underpinnings. The Cerebellum 2011 Dec; 10(4):770-92. Paul Beljan (602) 957-7600

  40. When Disorders are NOT Disorders: Koziol LF, Budding DE, Chidekel D. Adaptation, Expertise, and Giftedness: Towards an Understanding of Cortical, Subcortical, and Cerebellar Network Contributions. The Cerebellum 2010 Dec; 9(4):499-529. Goldberg, E. The Executive Brain: Frontal Lobes and the Civilized Mind. Oxford Press, 2001. Paul Beljan (602) 957-7600

  41. Paul Beljan, PsyD, ABPdN, ABN 9835 E. Bell Rd., Ste. 140 Scottsdale, AZ  85260 (602) 957-7600 www.beljanpsych.com p.beljan@beljanpsych.com Twitter@BeljanPsych http://motorcognition2.com/ Paul Beljan (602) 957-7600

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